【摘要】　目的　 观察帕瑞昔布钠超前镇痛在小儿上肢骨折手术的镇痛效果及不良反应发生情况。　方法　 选择2009年6月－2010年12月气管插管全身麻醉下择期行单侧上肢骨折切开复位内固定手术患儿90例，随机分为帕瑞昔布钠组（P组）、曲马多组（T组）及对照组（C组），每组各30例患儿；于麻醉前分别静脉注射帕瑞昔布钠1 mg/kg、曲马多2 mg/kg、等容量生理盐水。3组患儿年龄、性别、体重、手术时间等一般情况差异无统计学意义（P gt;0.05）。各组均于术后2、4、6、8 h各时间点观察患儿疼痛评分、镇静评分；观察拔除患儿气管导管后5 min躁动评分；记录患儿术中芬太尼总用量及术后镇痛药物用量；随访术后24 h内不良反应的发生情况。　结果　 术后各个时间点P组疼痛评分明显低于T、C组（P lt;0.01）；T组镇静评分于术后2、4、6 h明显高于P、C组（P lt;0.01），镇静评分在P、C组之间比较差异无统计学意义（P gt;0.05）；P组术后躁动评分明显低于T、C组（P lt;0.01）；P组患儿围手术期芬太尼用量明显少于T、C组（P lt;0.01）；T组术后恶心呕吐发生率明显高于P、C组（P lt;0.05）。P组无呼吸抑制、伤口异常出血等严重不良反应。　结论　 帕瑞昔布钠超前镇痛用于小儿上肢骨折手术可产生明显镇痛作用，并可有效预防苏醒期躁动发生，明显减少围手术期芬太尼用量，恶心呕吐等不良反应发生率明显低于曲马多。
【Abstract】　Objective　 To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery.　Methods　 Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation.　Results　 The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (P gt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (P lt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (P lt;0.01), but the sedation score did not differ significantly between groups P and C (P gt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (P lt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (P lt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (P lt;0.05). There was no depression of breath or abnormal hemorrhage in group P.　Conclusion　 Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.

Citation： LI Xiuze,LI Wei,XIA Qing. Clinical Study of Preemptive Analgesia with Parecoxib Sodium in Children Undergoing Upper Limb Orthopedic Surgery. West China Medical Journal, 2011, 26(8): 1189-1191. doi: Copy